The protocol has been approved by the NIH-NHLBI, George Mason University, and Inova Fairfax Hospital IRBs. A contract for the Protocol Manager, Michelle Kennedy, to oversee compliance with the protocol procedures was awarded as was a contract for a scientist from George Mason University, Dr. Randall Keyser. A site contract was awarded to Inova Fairfax Hospital to serve as a training site for subjects who have pulmonary hypertension. In the Rehabilitation Medicine Department, researchers and investigators have refined study implementation procedures (on paper). The modification includes expanding the exercise training sites to include the RMD as well as the Pulmonary Rehabilitation Center at Inova Fairfax Hospital. The inclusion/exclusion criteria were also amended to include patients with restrictive lung disease and pulmonary fibrosis. Investigators and project staff were trained on all technology including the newly acquired near infrared spectroscopy (NIR) muscle oxygenation monitor, new Medgraphics metabolic cart, and the Physioflow cardiac output monitor. Protocol manager Michelle Kennedy completed the preparation course for the ACSM Clinical Exercise Specialist certification and is awaiting the scores from her examination. The pilot study preceding actual data collection has been completed and seven healthy subjects have been tested. The purpose of these studies is to create a smooth operating environment and to assess any potential problems that we might encounter in exercise testing and training of patients and secondary hypertension. These healthy volunteers will help with safety assurance; the data will not be included in the final results. These subjects have been in the age range of those in the clinical trial: 21-74 years of age. The subjects have been healthy and have met all inclusion criteria for the pilot study including physical inactivity, no cardiorespiratory or pulmonary disease, no other disease of the neurological, metabolic, renal, or musculoskeletal system, and no medications that would influence aerobic capacity or treadmill performance. These subjects do not have any of the exclusion criteria specified for the pilot study including, but not limited to, ongoing tobacco use, pregnancy, mitochondrial disease, uncontrolled Diabetes Mellitus with a history of DKA or active substance abuse. The protocol opened for recruitment of subjects for the RCT portion of the project in January 2009. No enrollment has resulted, most likely due to stringent inclusion/exclusion criteria. The NHLBI, GMU and Inova IRBs have now approved modifications to the inclusion/exclusion criteria and the first subject is scheduled for baseline testing on September 17, 2009. Several others are in the scheduling process. No serious adverse events or protocol deviations have been reported for this study to date.